Anthracyclines are one of the most effective classes of drugs currently available for cancer diagnosed across the entire age spectrum. However, the therapeutic potential of anthracyclines is limited because of their strong dose-dependent relation with progressive and irreversible cardiomyopathy leading to congestive heart failure (Blanco et al., 2012; Grenier et al., 1998; Barry et al., 2008). This dose-dependent risk is modified by younger age at anthracycline exposure, chest radiation and co-existence of cardiovascular disease risk factors, such as hypertension and diabetes (Puma et al., 2008; Armenian et al., 2011). However, a significant inter-individual variability exists; cumulative anthracycline exposure as low as 150 mg/m2 results in cardiomyopathy in some patients, while exposure as high as 1000 mg/m2 is tolerated without cardiomyopathy by others (Bryant et al., 2007).
Thus, it would be beneficial to determine the reasons for the observed inter-individual variability and develop an optimal anthracycline dosage regimen for cancer patients based on the risk of developing cardiotoxicity from the effects of these drugs.